Adverse effects of propranolol when used in the treatment of hemangiomas: A case series of 28 infants

Graaf, Marlies de; Breur, Johannes M.P.J.; Raphaël, Martine F.; Vos, Marike; Breugem, Corstiaan C.; Pasmans, Suzanne G.M.A.

doi:10.1016/j.jaad.2010.06.048

Cited by 171 publications

(122 citation statements)

References 25 publications

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“…Efficacy was assessed by performing blinded volume measurements at weeks 0, 1, 2, 3,4,8,12,16,20, and 24 and blinded investigator photograph scoring at weeks 0, 12, and 24. Safety was assessed by measuring heart rate and systolic and diastolic blood pressure at weeks 0, 1, 2, 3,4,8,12,16,20, and 24.…”

Section: What This Study Addsmentioning

confidence: 99%

“…Increasingly, nonselective b-blockers, including propranolol hydrochloride, have replaced or been used in conjunction with previously recommended treatments such as systemic corticosteroids and vincristine for the treatment of IHs to prevent ulceration and disfigurement and for systemic involvement. 7,8 The mechanism via which b-adrenergic receptor antagonists inhibit the growth of IHs remains to be fully elucidated. Whereas the sideeffect profile of propranolol hydrochloride is favorable, 8,9 the potential for hypoglycemia, bronchial hyperactivity, and hypotension makes it difficult to justify its use for less severe IHs.…”

Section: What This Study Addsmentioning

confidence: 99%

“…7,8 The mechanism via which b-adrenergic receptor antagonists inhibit the growth of IHs remains to be fully elucidated. Whereas the sideeffect profile of propranolol hydrochloride is favorable, 8,9 the potential for hypoglycemia, bronchial hyperactivity, and hypotension makes it difficult to justify its use for less severe IHs.…”

Section: What This Study Addsmentioning

confidence: 99%

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RCT of Timolol Maleate Gel for Superficial Infantile Hemangiomas in 5- to 24-Week-Olds

Chan¹,

McKay²,

Adams

et al. 2013

Pediatrics

133

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WHAT'S KNOWN ON THIS SUBJECT:The systemic nonselective b-blocker propranolol hydrochloride is increasingly used as firstline management for infantile hemangiomas. Superficial nonulcerating lesions do not require systemic medications. Case series have suggested the efficacy of timolol; however, its safety has been questioned. WHAT THIS STUDY ADDS:This randomized controlled trial indicates that timolol maleate 0.5% gel is a well-tolerated, safe, and effective treatment of superficial infantile hemangiomas. abstract OBJECTIVE: Timolol maleate 0.5% gel is a safe and effective medication for treating superficial infantile hemangiomas (IHs) in infants with a median age of 9 weeks.METHODS: Forty-one infants who had superficial IHs without ulceration and not near mucosal surfaces were recruited and randomly assigned to placebo and treatment (timolol maleate 0.5% gel) groups. Efficacy was assessed by performing blinded volume measurements at weeks 0, 1, 2, 3,4,8,12,16,20, and 24 and blinded investigator photograph scoring at weeks 0, 12, and 24. Safety was assessed by measuring heart rate and systolic and diastolic blood pressure at weeks 0, 1, 2, 3, 4, 8, 12, 16, 20, and 24. RESULTS: Fifteen of the 19 infants receiving treatment and 17 of the 22 infants receiving placebo completed the study. Significant color change on the blinded photographic scores was noted at week 24 of the study (P = .003). There was a significantly higher proportion of treated IHs that reduced in size by .5% at weeks 20 and 24 (P , .02). The predicted proportion of IH volume change was also significantly less for treated IHs from week 16 onward when compared with placebo (P , .05). There was no significant variation in blood pressure and heart rate between the groups. CONCLUSIONS: Topical timolol maleate 0.5% gel with a maximum dose of 0.5 mg per day is a safe and effective option for small superficial IHs that have not ulcerated and are not on mucosal surfaces. Pediatrics

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Section: What This Study Addsmentioning

confidence: 99%

Section: What This Study Addsmentioning

confidence: 99%

See 1 more Smart Citation

RCT of Timolol Maleate Gel for Superficial Infantile Hemangiomas in 5- to 24-Week-Olds

Chan¹,

McKay²,

Adams

et al. 2013

Pediatrics

133

View full text Add to dashboard Cite

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“…Therapy should be temporarily discontinued in the event of intercurrent illness, such as vomiting, diarrhea, decreased oral intake, somnolence, or bronchiolitis. An uncontrolled case series showed a high rate (64 %) of mostly minor side effects in 18 of 28 infants treated with propranolol for IHs [40].…”

Section: Safety/adverse Effectsmentioning

confidence: 99%

Propranolol for Infantile Hemangiomas: A Review

Hogeling

2012

Curr Derm Rep

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Infantile hemangiomas (IHs) are the most common vascular tumors of infancy. Since it was discovered several years ago, propranolol hydrochloride has become a very popular and successful treatment for complicated and aesthetically disfiguring IHs. The recent literature on propranolol is reviewed, including a summary of larger studies, discussion of adverse effects, and the use of propranolol in complicated IHs, such as ulcerated IHs, airway, and hepatic IHs.

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“…14 However, an anecdotal reference to alleged direct binding of propranolol with GLUT1 has no scientifi c basis. 15 Regardless of the mechanism of action, it is now indisputable that propranolol has an important effect on infantile hemangiomas, such that it causes their rapid regression. 16 Other groups have also reported similar results, 17,18 omas.…”

mentioning

confidence: 99%

Treatment of children and adolescents with hemangioma using propranolol: preliminary results from a retrospective study

et al. 2014

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CONTEXT AND OBJECTIVE: Hemangiomas are the commonest vascular tumors during childhood. In 2008, the effect of propranolol for treating capillary hemangiomas was demonstrated. Other similar results followed, showing that it rapidly reduces lesion volume. The objective here was to evaluate children and adolescents with hemangiomas that were treated with propranolol. DESIGN AND SETTING: Retrospective study, conducted in a children's hospital. METHODS: Patients aged 0-19 years with or without previous treatment, who were treated between January 2009 and December 2010, were included. The response was assessed by comparing the lesion appearance between the start of treatment and the last consultation. We considered partial or complete responses as the response to treatment. RESULTS: Sixty-nine patients with a median follow-up of 11 months (mean age: 31 months) were included. Of these, 58 patients were recently diagnosed and 11 had had previous treatment. A response (partial or complete) was seen in 60 patients (87%). Among the capillary hemangioma cases, responses were seen in 50 out of 53 (94%), while in other lesion types, it was 10 out of 16 (63%) (P = 0.3; chi-square).Responses in patients less than one year of age were seen in 37 out of 38 (97%), whereas in those over one year of age, in 23 out of 31 (74%) (P = 0.4; chi-square). Side effects were uncommon and mild. CONCLUSIONS: Propranolol seemed to be effective for treatment of hemangiomas in children and adolescents, and not just in the proliferative stage, with responses in almost all the patients. Resposta (parcial ou completa) foi verificada em 60 pacientes (87%). Entre os hemangiomas capilares, a resposta foi de 50 em 53 (94%), enquanto em outros tipos de lesões, a resposta foi de 10 em 16 (63%) (P = 0,3; teste de qui-quadrado). A resposta em pacientes com até 1 ano de idade foi de 37 em 38 (97%), e naqueles com mais de 1 ano foi de 23 em 31 (74%) (P = 0,4; qui-quadrado). Efeitos colaterais foram incomuns e leves. CONCLUSÕES: Propranolol parece ser efetivo no tratamento de hemangiomas em crianças e adolescentes, não apenas na fase proliferativa, com resposta em quase todos os pacientes. RESUMO

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Adverse effects of propranolol when used in the treatment of hemangiomas: A case series of 28 infants

Cited by 171 publications

References 25 publications

RCT of Timolol Maleate Gel for Superficial Infantile Hemangiomas in 5- to 24-Week-Olds

RCT of Timolol Maleate Gel for Superficial Infantile Hemangiomas in 5- to 24-Week-Olds

Propranolol for Infantile Hemangiomas: A Review

Treatment of children and adolescents with hemangioma using propranolol: preliminary results from a retrospective study

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